Thursday, May 24, 2007

Perspectives on the Challenges in Global Health

Alumni Weekend is a wonderful time to catch up with old friends and celebrate our University and our School. Alumni Weekend also presents the opportunity to become engaged with Penn graduates from across the University through a variety of discussions and activities.

I recently had the opportunity to participate in a discussion on “Health in the Developing World: Meeting the Challenges,” hosted by the Leonard Davis Institute of Health Economics (LDI) and held at The Wharton School. LDI is a cooperative venture of the Schools of Nursing, Medicine, and Dental Medicine, Wharton, the Annenberg School of Communication, and Children’s Hospital of Philadelphia. Along with Dr. Richard Cooper from the School of Medicine and Dr. Mark Pauly from the Wharton School, we discussed three of the many pressing healthcare issues facing citizens around the world — the safety and health of women, worldwide physician and nursing shortages, and healthcare financing systems.

While it is true that around the world, the average life expectancy is higher for women than for men, the quality of life for women is much worse. Women are physically abused, maimed, killed for the actions of their families members, for what others perceive as inappropriate behavior, or simply for being female. Women are trafficked not only by “business associates,” but also by members of their families, and forced into teenage marriages. The many rules and traditions in the developing countries ignore the health, safety, and well-being of women. Achieving global health is not possible without empowering, educating, and financing women’s initiatives.

Global health is profoundly influenced by shortages of healthcare professionals. These shortages have prompted shifting of human resources from the developing to the developed world. Our discussion revealed that the developed world takes doctors and nurses away from countries that desperately need healthcare providers. AIDS, malaria, and other diseases are decimating the populations in Botswana, Sierra Leone and sub-Saharan African nations because there are not enough caregivers to provide care to those who need it most. The developed world has a moral obligation to address the shortage issue first in their countries as well as collaborating with international organizations in providing equitable solutions that are global.

Achieving better health is also not possible without reliable insurance systems available to all citizens. Many countries have universal healthcare, but out of pocket costs are too expensive for many residents, so costly that some families need to choose between paying for everyday necessities or paying for medical services. Solutions to this situation could include creating insurance systems that provide real support and creating community insurance programs in which members of villages pool their money in a common pot controlled by the community and used by the community in case of emergency.

For many of the discussion’s participants, this was the first time they had to opportunity to hear about world health issues directly from those who have been immersed in it for many years. It is an insightful learning experience for all to discuss health-related issues from different fields and perspectives, including engineering, law, and business. We brought to the discussion different angles on the global health problems and provided very different solutions. The different perspectives provided promoted conversations that are necessary to inspire action and evoke change. While it is easy to define the major problems, it is far more complex to outline action plans and even more complex to implement change. Thought leadership, partnership between different disciplines, and intersectional collaborations are “must have” ingredients for solving global health problems.

Tuesday, May 22, 2007

The Importance of Advanced Nursing Degrees

This month we celebrated the commencement of the 323 members of our Class of 2007. As we continue to fight the growing nursing shortage, each Penn Nursing graduation is a significant milestone — it means that we have prepared another outstanding cohort of exceptionally educated professionals who are ready to meet our nation’s healthcare needs.

In its April 15, 2007 issue, Parade magazine featured the article “The Hottest Jobs (No College Degree Required)” and included registered nurses in that category. After receiving numerous responses from the nursing community, including the president of the American Association of Colleges of Nurses (AACN), Parade issued the following apology:

“We [also] regret any misunderstanding that may have been caused by the
inclusion of registered nurses…. While non-college diploma and certificate
programs do exist for th[ese] occupation[s], the majority of RNs…have college
degrees and additional levels of training.”

While I am pleased that Parade acknowledged its error and issued a retraction, I am reminded again that many journalists still do not differentiate between different educational levels nor understand the value and importance of BSN, MSN, and PhD degrees in the field of nursing and how these degrees relate to the quality of care delivered.

The American Nurses Association, American Organization of Nurse Executives (AONE), and AACN have declared that all practicing nurses should have at least a BSN. The AONE declared the BSN as the degree of choice for practicing nurses. Why?

At the University of Pennsylvania School of Nursing, our undergraduates are taught not only the fundamentals required for practice, but also the importance of incorporating nursing research, ethics, history, and humanities into their work. Over the course of their four years as baccalaureates, our students are encouraged to participate in faculty research projects in our research centers of excellence. Our students have the opportunity to advance their knowledge base and to develop the evidence for best practice models. They are given the opportunities to study abroad and to enroll in a joint degree program in health care management with Penn’s Wharton School. Clearly, when Penn Nursing students graduate, they are ready to hold responsible positions in all healthcare settings and are on track to become expert clinicians, managers, care coordinators, and faculty members who will teach the next generation of nurses.

During four years of study, BSN students experience complex clinical judgment and experiment with critical thinking through on-site clinical rotations in a variety critical care, home health, public health, and community settings. They have learned not only how to care for patients across the healthcare continuum and coordinate care plans with other providers, they have also acquired the skills necessary to make quick, clinical judgments and life saving decisions.
This is why nurses with BSNs and higher degrees are in demand. Dr. Linda Aiken, Penn Nursing’s own Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research, and her research team reported in the Journal of the American Medical Association in 2003 that hospitals with a higher proportion of nurses with bachelor’s degrees have a lower mortality rate. In fact, each 10 percent increase in proportion of staff nurses with BSNs is associated with a five percent decline in mortality and a five percent decline in failure to rescue patients experiencing a complication.

Hospitals and healthcare institutions cannot afford the consequences of undereducated nurses. The universal requirement of a minimum of a bachelor’s degree should be adopted to make some of the “hottest jobs” in America safer for everyone. We are proud of our graduates for what they achieved and for what they will accomplish.